Chapter OneInsomnia is a Major Problem
Almost everyone has an occasional problem with sleeping poorly. It may be the night before a final exam in school or during a time of major stress such as the death of a loved one. Most people may have experienced the insomnia associated with severe jet lag after a long airline trip. You know how frustrating it can be to be unable to sleep when you want and need to but your body wants to be wide awake! In fact, close to 50% of people in our culture have an intermittent but recurrent problem with difficulty sleeping. Insomnia is the most common sleep related disorder and is one the most frequent reasons a person visits a doctor. While for most, insomnia is just occasional, for some it is a chronic problem of nightly insomnia that pesters them for months or years. About 10% of people have some ongoing insomnia nightlya huge number particularly when you consider how debilitating insomnia can be.
Case Study #1Mike: He Just Can't Seem to Fall Asleep
Mike recently graduated from college and now has a responsible job with an accounting firm. He often has to take work home in the evening to complete it but is expected to be at work ready to go at 8am. He enjoys his work but just wishes he could stop thinking about all the details when he's done for the day. Starting about three months ago, he began having some problems falling asleepnot every night, but about half the time. Typically, once he fell asleep, he slept pretty soundly. However, this last month he's had trouble falling asleep every single night. Once he didn't fall asleep until an hour before his alarm went off! He's never had a sleep problem before.
Everyone has suggestions for him about his insomnia. He's tried doing a really hot bath and an aerobics work out just before bed so he'd be really tired and relaxed but, amazingly, it just made him more awake than ever. One friend recommended a stiff drink of brandy every night as a cure while others have suggested their favorite bedtime herbal remedy. So far he's tried every single one of them. Some even help for a few nights before they stop working. Mike is actually starting to get nervous when he knows bedtime is approaching. Mike thinks to himself, "Not another night where I can't go to sleep! I just can't stand it." The quality of his work has begun slipping and he's getting grouchy and irritable. Once he even slept right through his alarm and was three hours late for work. He sees prescription sleep medication advertised everywhere but he doesn't want to get addicted to a medication. Mike sees that his insomnia problem is now a downward spiral but he hasn't got a clue what to do.
It turns out that Mike's particular insomnia problem is likely straightforward. He has developed very poor sleep "habits" and his body and mind have learned this insomnia behavior very well in just a few short months! Fortunately for Mike, he can easily learn the right habits and attitudes for sound sleep. When this is coupled with special relaxation techniques to get him ready for sleep every night his problem will likely vanish within weeks. Also, he'll have a clear understanding how to keep his sleep deep and refreshing for a lifetime. The techniques and information in this book would be ideal for him.
Case Study #2Susan: She Keeps Waking Up All Night
Susan is a high school teacher who loves teaching. About six months ago, her marriage of eight years ended. Even though she and her "ex" parted on friendly terms she's been feeling pretty flat emotionally and nothing seems to interest her much. For example, she just hasn't had her normal energy to prepare her lesson plans for school. Right after the break-up, she began having sleep problems. She falls asleep fine, in fact, she looks forward to going to bed hoping tomorrow she'll be rested and energetic. It's too bad, but after a few hours she wakes up and can't go back to sleepusually for about an hour but sometimes the rest of the night! She'll keep waking up every few hours like this until morning. On school days, she wishes she could "sleep in" but she needs to get up and ready for work. Sometimes on the weekend she'll stay in bed for 14 hours at a stretch but will actually sleep only about half of thatthe rest of the time she just lays there. She had trouble like this about fifteen years ago after she was let go during a "down sizing" at her previous school. That time, however, her sleep got better after a few months.
Now, she's stopped exercising simply because she's too tired in the evening and has gained about 10 lbs in the last three months. She stopped seeing friends in the evening at all because she wants to get to bed early. Her self-esteem is in the dumps. She finally went to her doctor to get some sleeping pills and to her surprise was offered an anti-depressant medication. She told her doctor, "I'm not depressed. In fact, if I just had a good night's sleep, I'd be fine. I just need a pill to keep me asleep."
Susan has a kind of insomnia sometimes called "early awakening" where she awakens in the middle of the night and can't go back to sleep. In Susan's case, her insomnia is likely being caused by the mild depression she's experiencing. Her sleep disturbance is actually one of the clues. While most people with insomnia simply have a sleep disorder for some it will be the chief sign of an underlying problem like depression or anxiety. Susan also made her insomnia symptoms worse by some of the negative life style changes that she'd recently made, like stopping her exercise program. Susan will benefit from a sleep program such as outlined in this book but she may need to address her depression more directly if her symptoms continue.
What is Insomnia?
Simply put, insomnia is the inability to have a refreshing night's sleep when you want it. The problems that are typical in insomnia include difficulty falling asleep or with waking up during the night and being unable to return to sleep rapidly, as we've seen in our two case studies. The real key to understanding insomnia is that it's not just about the total amount of sleep time one has, it's the inability to have sleep that leaves one refreshed in the morning. Actually sleep requirements are highly individual. One person may feel completely recharged after only 6 hours sleep. Another may require a full eight hours for the same level of rejuvenation. If you are that "eight hour a night" person who sleeps only six hours, you may feel sleep deprived the next day.
Not everyone who gets inadequate sleep is suffering from insomnia. Many people who are sleep deprived are missing sleep by choice or because they are forced by their circumstances to limit their sleep time. For example, a surgeon on night call at a hospital or a mother caring for her sick children may get less than three hours of sleep one night, which is enough to hurt their function the next day. However, they may not have any problem with insomnia. Given the chance to sleep, and they would probably love it, they would sleep normally.
The Consequences of Inadequate Sleep
Sleep deprivation caused by insomnia or by simply not sleeping enough can affect your daytime function tremendously. If you are sleep deprived, you can have memory problems, difficulty concentrating, poor social interactions, daytime sleepiness and fatigue, as well as annoying symptoms of physical stress such as headaches and gastrointestinal woes. There are even problems with decreased immune function. While those with mild or short-term insomnia (less than a month) may find that this has limited effects on their daytime function, those with chronic insomnia may have significant trouble with their performance during the day. For example, those with chronic insomnia are twice as likely to have auto accidents as those who sleep normally.
Many people in our culture are not sleeping enough. Students often stay up late but leave for school very early and some are chronically under sleeping. People who work at jobs that have shifts may sleep less. Because they sleep and work at unusual times compared to the rest of us, the typical shift worker sleeps 8 hours less a week than those with normal work schedules. Some professions like health care demand long hours of night call with little or no sleep. For our culture as a whole, we sleep 25% less than our ancestors did a hundred years ago but there is no evidence that shows we need less sleep than they did. Also, with the current 24 hour a day availability of TV, shopping, and the Internet we can find many excuses at home to delay or forgo adequate sleep.
When a person's sleep patterns become distorted by choice or life's circumstances, they may go on to develop insomnia where they cannot sleep when they want to. This very common form of insomnia is actually from bad sleep habits their bodies have learned. This was Mike's problem in our case studies. Poor sleep habits are often referred to as "poor sleep hygiene."
It Can Be Hard to Tell How Much Sleep Deprivation is Affecting You
Those who are sleep deprived may be unaware how impaired they are. One study done at a sleep laboratory where volunteers were kept awake constantly for days at time found that the mental abilities of the subjects as measured by standardized tests worsened with each passing day. The curious thing was that the volunteers often commented that as the number of sleepless days increased they felt like they were "adjusting to the lack of sleep" and were convinced they were starting to perform better on those tests even as their actual scores worsened!
Studies done on sleep deprived professional truck drivers done in a laboratory using driving simulators found that they often couldn't tell they were beginning to nod off while driving. They would simply awake with great surprise to find they had driven the simulator into a ditch!
One sobering study looked at how surgeons performed the day after spending a night on call when they got less than 3 hours sleep in total. They were compared to surgeons who were normally rested when performing a particular surgical task. The "under slept" surgeons coming off a night on call took 40% longer doing the surgical task and made twice as many errorsall from just one night of very inadequate sleep! Frequent insomnia can cause significant sleep deprivation over time and potentially puts you and those around you at risk.
Insomnia: a $100 Billion Dollar Problem
As you can see, those with insomnia may be really suffering. The less you sleep because of insomnia the more likely you are to feel lousy and have other sleep deprivation symptoms the following day. With very intermittent insomnia there may be little in the way of bad effects. However, if you have severe chronic insomnia, you are quite likely to have significant impairments and complaints. Roughly half of those with insomnia complain of not feeling well physically. This is what will often get them to finally go see a doctor. Longstanding insomnia predisposes you to depression and anxiety problems. Some people actually develop tremendous anxiety over not sleeping well as we saw in Mike's case.
Out of frustration at being unable to sleep, many insomniacs become dependent on alcohol or other sedatives to put them to sleep. In fact, about 10% of alcoholics became alcohol dependent because of insomnia initially! Many others take non-prescription sleeping pills nightly and the side effect of these drugs can also negatively affect their function the next day. You can end up dependent on these over-the-counter medications that give only unnatural and unrefreshing sleep.
Put bluntly the effect of insomnia on our culture is catastrophic. The costs of all the problems caused by insomnia are staggeringparticularly if we look at those who are sleeping less than 5 and 1/2 hours a night. If we include fatigue related accidents, poor job performance, absenteeism, and the expense of sleep medications, the cost totals over 100 billion dollars a year! There are untold deaths yearly from auto accidents caused by sleepy drivers. Lost jobs, lost promotions, lost friendships, and decreased productivity at work can all result from the simple inability to sleep.
Not Many with Insomnia Seek Medical Helpin Part Because Many Doctors have Difficulty Treating Insomnia
Surprisingly few insomniacs, even those with severe symptoms, seek medical help. Less than 15% of those with insomnia have seen a doctor and less than a third of those seen come away from their visit with a clear understanding of their problem. When a patient with insomnia visits their doctor, they may find that their physician is ill equipped to help them. The scientific understanding of insomnia and its treatment has advanced considerably in the last twenty years but the average physicians' understanding has often lagged behind. Even many conscientious physicians don't understand that patients really need to be educated in depth about insomnia and need to be taught about ways they can help themselves to sleep betternot simply given a sleeping pill prescription.
Studies reveal that the treatment of insomnia tends to be frustrating for the patient and the doctor with the outcome frequently unsatisfactory for both. The average physician when confronted with a somewhat desperate patient with severe insomnia may inwardly be saying, "Oh no, not another one!" Often physicians simply reach for their prescription pads out of frustration or a lack of time. The drugs typically prescribed for insomnia by physicians are designed for short term or occasional use only. No one really wants to be dependent on drugs to sleep.
A Lasting Fix for Insomnia is Possible
However there is good news. Modern research has shown that giving a patient a few simple lifestyle rules, easy and enjoyable techniques to help relax, and specific suggestions for their sleep routine works as well as prescription sleeping pills and it is natural sleep not chemically induced. These techniques will often provide a lasting "fix" to sleep problems. Even if medication is needed initially as an aide, it can often be discontinued over time as long as you are doing other positive things to keep sleeping well.
Obviously, helping you change your sleep habits and routine, teaching you relaxation techniques to prepare for sleep, and giving you positive sleep affirmations, is more helpful and much safer than taking sleeping pills in the long run. This book will train you to use the Ananda Yoga system as a way of improving your sleep. When done in conjunction with the other well-researched lifestyle modifications we suggest, it is a powerful tool to restore normal sleep patterns. Using this "non drug" approach to insomnia we expect the vast majority of people will not only sleep better but many can eliminate their use of sleep medication.
First let's look at what constitutes normal sleep and some of the causes of insomnia. Then we'll show you how Ananda Yoga can be used in a program to improve your sleep patterns. Lastly, we'll look at other ractical suggestions for getting a great night's sleep